Screening for sinus node dysfunction by analysis of short-term sinus cycle variations on the surface electrocardiogram

• Published in: The American heart journal 1995-07, Vol.130 (1), p.141-147
• Main Authors: Bergfeldt, Lennart, Rosenqvist, Mårten, Vallin, Hans, Nordlander, Rolf, Åström, Hans
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Arrhythmia, Sinus - diagnosis; Arrhythmia, Sinus - drug therapy; Arrhythmia, Sinus - physiopathology; Biological and medical sciences; Confidence Intervals; Electrocardiography - drug effects; Electrocardiography - instrumentation; Electrocardiography - methods; Electrocardiography - statistics & numerical data; Electrocardiography, Ambulatory; Electrocardiography. Vectocardiography; Electrodiagnosis. Electric activity recording; Female; Heart Rate - drug effects; Humans; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Periodicity; Prospective Studies; Sensitivity and Specificity; Sinoatrial Node - drug effects; Sinoatrial Node - physiopathology; Time Factors
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(95)90249-X

A new noninvasive screening method for diagnosing sinus node dysfunction (SND) was evaluated. Sinus cycle variations from 1-minute electrocardiograms (ECG) were described by two variables: the variation range around the mean cycle length (percentage) and the maximal change between any two consecutive cycles (milliseconds). SND was diagnosed when both variables were increased. Part 1: Validation of this method against Holter and sinus node recovery time assessment in 69 patients with proven or possible sick sinus syndrome (SSS). Part 2: Application of the method to 60 patients with clinically significant cardiovascular and pulmonary disorders (group 3), but without any pretest suspicion of SND. Part 1: Sinus cycle variations and sinus node recovery times were abnormal in similar proportions, 55% and 63%, respectively. The sensitivities in proven SSS were 72% and 71%, respectively. Sinus node function was concordantly classified in 80% of 64 patients undergoing both tests. When sinus cycle variations were abnormal the probability of a prolonged recovery time was 89%. Part 2: Asymptomatic SND was found in 12% of patients in group 3. Thus, analysis of short-term beat-to-beat variations in the surface ECG has a sensitivity of approximately 70% and a specificity of 100% for diagnosing SND.